What are the first signs of Paget disease of the breast?

Paget disease affects the nipple and the darker skin around it. The area may look irritated, feel sore, or develop a dry, eczema-like surface. The nipple can become flatter or turn inward, and a lump may be present deeper in the breast, although a lump is not required. These findings can also result from dermatitis, infection, friction, or other benign breast conditions. A persistent change on one side should not be assumed to be ordinary skin irritation.

Arrange a breast assessment if nipple or areola changes do not settle, recur, or are accompanied by a lump or discharge. Avoid repeatedly applying new creams before assessment because they can alter the skin appearance. A clinician may examine the breast and arrange imaging; a small skin or nipple sample may be needed to clarify the cause. If Paget disease is confirmed, treatment planning may include lumpectomy or mastectomy depending on the area involved and other findings.

Seek prompt medical advice for bloody or clear discharge from one nipple, a new nipple inversion, a growing breast lump, ulceration, or redness that spreads with warmth and pain. Seek urgent help if you have fever with rapidly worsening breast redness or feel acutely unwell, as infection may require immediate treatment.

Ask whether the appearance fits eczema, infection, or another breast condition; whether imaging or a biopsy is needed; and how results will be explained. If Paget disease is found, ask which surgery is being considered and how the plan relates to any underlying breast abnormality.